Less Is More

Simpler & Better Medicine

Clinical Intuition as a Risk Stratification Method for Provision of Care Management Services. — May 22, 2018

Clinical Intuition as a Risk Stratification Method for Provision of Care Management Services.

Summary: For primary care practices seeking to enroll high-risk patients in care management, use of clinical intuition to identify high-risk patients may be associated with a higher proportion of patients being enrolled in care management compared to use of an algorithm, insurance claims, or electronic health record (EHR) based tools.

https://www.ncbi.nlm.nih.gov/m/pubmed/28893815/

Strength of Recommendation = B

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Vertebroplasty or sham procedure for painful acute osteoporotic vertebral compression fractures. — May 15, 2018

Vertebroplasty or sham procedure for painful acute osteoporotic vertebral compression fractures.

Summary: For patients with an acute osteoporotic vertebral compression fracture, use of a “sham” procedure appears to be associated with the same degree of pain reduction over one day to 12  month follow up as use of vertebroplasty with cement, but without the associated risks of adverse events.

https://www.ncbi.nlm.nih.gov/m/pubmed/29743284/

Strength of Recommendation = B

 

Sitting at patients’ bedsides may improve patients’ perceptions of physician communication skills. — May 8, 2018

Sitting at patients’ bedsides may improve patients’ perceptions of physician communication skills.

Summary: For inpatient hospital visits, if the rounding physician sits the patient is more likely to feel that the physician explained things clearly and listened carefully without the visit taking any longer than if the physician remains standing for the visit.

https://www.ncbi.nlm.nih.gov/m/pubmed/27378679/

Strength of Recommendation = B

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome. — May 1, 2018

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome.

Summary: For patients with chronic patellofemoral pain syndrome (PFPS),  treatment with an 8-week home exercise program appears to lead to the same improvement in pain and function at 9 months as treatment with knee arthroscopy + an 8-week home exercise program, but the exercise-only approach is associated with significantly lower costs.

https://www.ncbi.nlm.nih.gov/m/pubmed/18078506/

Strength of Recommendation = B

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. — April 24, 2018

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture.

Summary: For adults with painful osteoporotic vertebral fractures, not treating with percutaneous vertebroplasty may be associated with the same degree of subsequent pain relief, disability and quality of life as treating with vertebroplasty, while not treating with vertebroplasty would avoid the potential rare but serious associated complications of osteomyelitis, cord compression, thecal sac injury and respiratory failure.

https://www.ncbi.nlm.nih.gov/m/pubmed/29618171/

Strength of Recommendation = A

Delayed vs immediate prescription of antibiotics for adults with uncomplicated lower respiratory tract infections. — April 17, 2018

Delayed vs immediate prescription of antibiotics for adults with uncomplicated lower respiratory tract infections.

Summary: For adults with lower respiratory tract infections, prescribing delayed antibiotics (giving the patient a prescription to fill if not feeling better in 2-3 days) may be associated with a lower rate of return consultations for new or worsening symptoms compared to prescribing antibiotics to be started immediately; without any increased risk of hospital admission or death.

https://www.ncbi.nlm.nih.gov/m/pubmed/28533265/

Strength of Recommendation= B

General exercise vs resistance band training in multidisciplinary rehabilitation of low back pain. — April 10, 2018

General exercise vs resistance band training in multidisciplinary rehabilitation of low back pain.

Summary: For patients with chronic low back pain, general physical exercise may lead to the same level of improvement in disability at 3 months as progressive resistance training, but general physical exercise may be associated with improved function.

https://www.ncbi.nlm.nih.gov/m/pubmed/29603805/

Strength of Recommendation = B

Home versus in-patient treatment for deep vein thrombosis. — April 3, 2018

Home versus in-patient treatment for deep vein thrombosis.

Summary: For patients with deep vein thrombus (DVT), treatment at home with low-molecular weight heparin (LMWH) appears to be associated with a lower likelihood of recurrence of venous thromboembolism (VTE), and may be associated with greater improvements in quality of life, compared to hospital treatment of DVT with unfractionated heparin (UFH) or LMWH.

https://www.ncbi.nlm.nih.gov/m/pubmed/29315455/

Strength of Recommendation = B

Menthol Cough Drops and Cough Severity. — March 27, 2018
Opioid vs Nonopioid Medications & Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain. — March 20, 2018

Opioid vs Nonopioid Medications & Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain.

Summary: For patients with moderate or severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, use of non-opioid analgesics (eg, acetaminophen or non-steroidal anti-inflammatory medications) instead of opioid pain analgesics (eg, morphine, oxycodone, or hydrocodone/acetaminophen) may lead to both lower pain intensity and lower likelihood of side effects over 12 months.

https://www.ncbi.nlm.nih.gov/m/pubmed/29509867/

Strength of Recommendation = B

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty. — March 13, 2018

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.

Summary: For patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) , postoperative venous thromboembolism (VTE) prophylaxis with rivaroxaban for 5 days followed by aspirin for an additional 9 days after TKA or an additional 30 days after THA may be associated with the same risk of VTE as full course of VTE prophylaxis with rivaroxaban for 14 days after TKA or 35 days after THA; however prophylaxis with aspirin is much less expensive.

https://www.ncbi.nlm.nih.gov/m/pubmed/29466159/

Strength of Recommendation = B

Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism. — March 6, 2018

Comparison of the unstructured clinician gestalt, the wells score, and the revised Geneva score to estimate pretest probability for suspected pulmonary embolism.

Summary: For patients with suspected pulmonary embolism (PE), “clinical gestalt” may be more accurate than at predicting which patients are at low risk of PE than either the Wells or Geneva scores, and may be more accurate at predicting which patients are at high risk of PE than the Wells score; and for both situations clinical gestalt may be arrived at more quickly than a calculated risk score.

https://www.ncbi.nlm.nih.gov/m/pubmed/23433653/

Strength of Recommendation = B

Pulmonary Embolism Rule-Out Criteria (PERC) and Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients — February 27, 2018

Pulmonary Embolism Rule-Out Criteria (PERC) and Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients

Summary: For patients who seem to be clinically at low risk of pulmonary embolism (PE), use of the pulmonary embolism rule-out criteria (PERC) to determine whether further testing is needed may be just as effective as conventional care at reducing the risk of subsequent PE, but use of PERC may be associated with a lower likelihood of receiving CT pulmonary angiography.

https://www.ncbi.nlm.nih.gov/m/pubmed/29450523/

Strength of Recommendation = B

Bed rest or early ambulation in the management of pulmonary embolism and deep vein thrombosis. — February 20, 2018

Bed rest or early ambulation in the management of pulmonary embolism and deep vein thrombosis.

Summary: For patients with acute pulmonary embolism (PE) or deep vein thrombosis (DVT) an approach of anticoagulation + early ambulation is associated with the same risk of new PE as an approach of anticoagulation + bed rest, and early ambulation might be associated with a lower risk of of new PE.

https://www.ncbi.nlm.nih.gov/m/pubmed/18691773/

Strength of Recommendation = A

Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. — February 13, 2018

Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review.

Summary: For patients with degenerative arthritis of the knee, conservative management may be associated with the same levels of pain and function at two years as knee arthroscopy, and conservative management may be associated with a lower risk of the adverse effects that can accompany surgery.

https://www.ncbi.nlm.nih.gov/m/pubmed/28495819/

Strength of Recommendation = B

Pain Relief After Operative Treatment of an Extremity Fracture. — February 6, 2018

Pain Relief After Operative Treatment of an Extremity Fracture.

Summary: For patients receiving operative treatment for a single extremity fracture, using acetaminophen alone for post-discharge analgesia may not be inferior for providing satisfaction with treatment compared to post-discharge analgesia with acetaminophen plus tramadol; while treatment with acetaminophen alone might be associated with a lower risk for side effects and for medication habit-forming.

https://www.ncbi.nlm.nih.gov/m/pubmed/29135664/

Strength of Recommendation = B

Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners. — January 30, 2018
Clinician attire and credibility of treatment. — January 23, 2018

Clinician attire and credibility of treatment.

Summary: For primary care clinicians caring for patients with low back pain (and presumably other conditions as well?), wearing casual attire appears to result in the same “perceived treatment credibility” as wearing formal attire, while casual attire is presumably more comfortable for the clinician.

https://www.ncbi.nlm.nih.gov/m/pubmed/27522250/

Strength of Recommendation = B

Genotype-guided or clinical dosing of warfarin — January 16, 2018

Genotype-guided or clinical dosing of warfarin

Summary: For patients being treated with warfarin anticoagulation, dosing of warfarin based on clinical protocols is associated with the same percentage of time with the INR in the desired therapeutic range, the same risk of an INR greater than 4, and the same likelihood of major bleeding or thromboembolism as “genotype guided” dosing of warfarin; while protocol-based dosing might be associated with lower initial costs.

https://www.ncbi.nlm.nih.gov/m/pubmed/24935087/

Strength of Recommendation = A

Bed Rest versus Early Ambulation and Headache after Spinal Anesthesia — January 9, 2018
Catheter-Directed Thrombolysis for DVT. — January 2, 2018

Catheter-Directed Thrombolysis for DVT.

Summary: For patients with acute proximal deep-vein thrombosis (DVT), an approach of anticoagulation alone is associated with a lower short-term risk of major bleeding compared to an approach of using using pharmacomechanical catheter-directed thrombolysis (PCDT) + anticoagulation; but there appears to be no difference between the two approaches in overall occurrence of post-thrombotic syndrome at 24 months, recurrent DVT at 24 months, or improvement in quality of life at the end of 24 months.

https://www.ncbi.nlm.nih.gov/m/pubmed/29211671/

Strength of Recommendation = B

Dexamethasone Versus Prednisone for Children with Acute Asthma. — December 26, 2017

Dexamethasone Versus Prednisone for Children with Acute Asthma.

Summary: For children with acute exacerbation of asthma, two doses of dexamethasone may lead to the same degree of symptom control at 7 days, the same quality-of-life scores at 7 days, and the same rates of hospital admission or return visit for emergency care as a 5 day course of prednisone, with a higher rate of treatment adherence.

https://www.ncbi.nlm.nih.gov/m/pubmed/29173304/

Strength of Recommendation = B

Narrow- vs Broad-Spectrum Antibiotics for Children With Acute Respiratory Tract Infections — December 19, 2017

Narrow- vs Broad-Spectrum Antibiotics for Children With Acute Respiratory Tract Infections

Summary: For children with acute respiratory infections (eg, otitis media, acute sinusitis, or group A streptococcal pharyngitis) treatment with narrow-spectrum antibiotics (eg, penicillin or amoxicillin) may be associated with the same risk of treatment failure at 30 days (approximately 8%) as broad-spectrum antibiotics (amoxicillin-clavulanate, cephalosporins, or macrolides), however broad-spectrum antibiotics may be associated with a higher risk of adverse events requiring clinical care (NNH = 100) and a higher risk of patient-reported adverse events (NNH = 10).

https://www.ncbi.nlm.nih.gov/m/pubmed/29260224/

Strength of Recommendation = B

HEART vs GRACE vs TIMI score to predict MACE in chest pain patients at the ED. — December 12, 2017

HEART vs GRACE vs TIMI score to predict MACE in chest pain patients at the ED.

Summary: For patients presenting to emergency care with chest pain, use of the 5 item HEART score allows better discrimination between those at high and low risk of major adverse cardiac events (MACE) over the next 6 weeks compared to use of either the 7 item TIMI score or the 8-item GRACE score.

https://www.ncbi.nlm.nih.gov/m/pubmed/27810290/

Strength of Recommendation = B

Endovascular vs open repair for ruptured abdominal aortic aneurysm. — December 5, 2017

Endovascular vs open repair for ruptured abdominal aortic aneurysm.

Summary: For patients with a clinical diagnosis of ruptured abdominal aortic aneurysm (AAA), a strategy of endovascular repair may be associated with fewer days in hospital, lower average costs, and improved 3-year survival compared to a strategy of open surgical repair.

https://www.ncbi.nlm.nih.gov/m/pubmed/29138135/

Strength of Recommendation = B

Treatment for subacromial shoulder pain (CSAW trial) — November 28, 2017

Treatment for subacromial shoulder pain (CSAW trial)

Summary: For patients who have subacromial pain with intact rotator cuff tendons and incomplete symptom relief after exercise therapy and at least one corticosteroid injection, an approach of arthroscopy-only may provide the same reported shoulder pain and function at 6 months as an approach of arthroscopic surgical decompression; and both approaches may provide only minimally better pain and function at 6 months compared to an approach of “no further intervention.”

https://www.ncbi.nlm.nih.gov/m/pubmed/29169668/

Strength of Recommendation = B

Auscultation While Standing May Help Exclude a Pathologic Heart Murmur in Children. — November 21, 2017

Auscultation While Standing May Help Exclude a Pathologic Heart Murmur in Children.

Summary: For children (between ages 2 and 18 years old) with a heart murmur detected on seated physical exam, complete disappearance of the murmur on standing may be more highly predictive that the murmur is benign and that additional testing is not needed than other traditionally-taught clinical features used to distinguish physiologic from pathologic murmurs.

https://www.ncbi.nlm.nih.gov/m/pubmed/29133490/

Strength of Recommendation = C

Single Dose of Oral Non-Opioid and Opioid Analgesics for Acute Extremity Pain — November 14, 2017

Single Dose of Oral Non-Opioid and Opioid Analgesics for Acute Extremity Pain

Summary: For adult patients with moderate to severe acute extremity pain, treatment with ibuprofen (400mg) + acetaminophen (1000mg) may provide the same amount of analgesia at 2 hours as treatment with either oxycodone (5mg) + acetaminophen (325mg) or hydrocodone (5 mg) + acetaminophen (300mg); but without the need for use of an opioid medication.

https://www.ncbi.nlm.nih.gov/m/pubmed/29114833/

Strength of Recommendation = B

Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin for Uncomplicated Cellulitis — November 7, 2017

Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin for Uncomplicated Cellulitis

Summary: For patients with uncomplicated cellulitis (no wound, no abscess, no purulent drainage), treatment with cephalexin for 7 days may provide the same rates of clinical cure as treatment with cephalexin + trimethoprim -sulfamethoxazole for 7 days; but with a simpler antibiotic regimen.

https://www.ncbi.nlm.nih.gov/m/pubmed/28535235/

Strength of Recommendation = B

Routine Low-Dose Oxygen in Adults With Acute Stroke — October 31, 2017

Routine Low-Dose Oxygen in Adults With Acute Stroke

Summary: For adult patients who have experienced an acute stroke and who do not have any other clinical indication for oxygen supplementation; an approach of not providing supplemental oxygen unless there is a clinical indication appears to be associated with the same functional status at 90 days as an approach of providing prophylactic supplemental oxygen for the first 3 days in hospital.

https://www.ncbi.nlm.nih.gov/m/pubmed/28973619/

Strength of Recommendation = B

Inpatient Rehabilitation vs Monitored Home-Based Rehabilitation after Total Knee Arthroplasty — October 24, 2017

Inpatient Rehabilitation vs Monitored Home-Based Rehabilitation after Total Knee Arthroplasty

Summary: For patients having primary total knee replacement for osteoarthritis of the knee, a clinician-monitored home-based rehabilitation program appears lead to the same performance on a 6-minute walk test at the end of therapy as a program of inpatient rehabilitation followed by home rehabilitation (however, patient satisfaction could be lower with home-based-only rehabilitation)

https://www.ncbi.nlm.nih.gov/m/pubmed/28291891/

Strength of Recommendation = B

End-of-Life Care in Older Patients After Serious or Severe Traumatic Brain Injury. — October 17, 2017

End-of-Life Care in Older Patients After Serious or Severe Traumatic Brain Injury.

Summary: For patients over 65 who suffer severe traumatic brain injury (TBI), an approach of providing hospice or palliative care may be associated with a lower likelihood of in-hospital mortality than an approach of providing high-intensity treatments (including gastrostomy and tracheostomy).

https://www.ncbi.nlm.nih.gov/m/pubmed/28975244/

Strength of Recommendation = B

Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children. — October 10, 2017

Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children.

Summary: For patients under 21 years of age suspected to have community-acquired pneumonia (CAP), use of lung ultrasound for diagnostic testing may decrease the number of chest x-rays needed, thereby minimizing radiation exposure and reducing cost (absolute risk reduction 38.8% [95% CI, 30.0%-48.9%]), without any increased risk of missed cases of CAP.

https://www.ncbi.nlm.nih.gov/m/pubmed/26923626/

Strength of Recommendation = B

Pain over speed bumps in diagnosis of acute appendicitis. — October 3, 2017

Pain over speed bumps in diagnosis of acute appendicitis.

Summary: For evaluation of adult patients suspected to have acute appendicitis, a history of increased pain when driving over speed bumps may have the same positive predictive value as a physical examination finding of rebound tenderness, with a better negative predictive value than rebound tenderness.

https://www.ncbi.nlm.nih.gov/m/pubmed/23247977/

Strength of Recommendation = B

Managing High-Altitude Pulmonary Edema with Oxygen Alone. — September 27, 2017

Managing High-Altitude Pulmonary Edema with Oxygen Alone.

Summary: For healthy patients who experience high-altitude pulmonary edema (HAPE), treatment with only oxygen + bedrest may be associated with the same time to resolution of HAPE as treatment with oxygen + bedrest + nifedipine, and might be associated with a shorter time to resolution of HAPE than oxygen + bedrest + dexamethasone.

https://www.ncbi.nlm.nih.gov/m/pubmed/27906598/

Strength of Recommendation = B

Preoperative hair removal to reduce surgical site infection. — September 19, 2017
Oxygen Therapy in Suspected Acute Myocardial Infarction — September 12, 2017

Oxygen Therapy in Suspected Acute Myocardial Infarction

Summary: For patients with suspected acute myocardial infarction (AMI) and an oxygen saturation 90% or higher at baseline, an approach of providing ambient air only (ie, no supplemental oxygen) may be associated with no difference in the risk of death from any cause within 1 year or rehospitalization with AMI within 1 year compared to an approach of providing supplemental oxygen (6 liters per minute for 6 to 12 hours).

https://www.ncbi.nlm.nih.gov/m/pubmed/28844200/

Strength of Recommendation = B

Over-the-counter transdermal lidocaine 3.6% menthol 1.25%, Rx lidocaine 5% and placebo for back pain and arthritis. — September 5, 2017
Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in Patients With Heart Failure. — August 29, 2017

Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in Patients With Heart Failure.

Summary: For patients with chronic heart failure and an ejection fraction ≤40%, outpatient management in accordance with published guidelines may be associated with the same time-to-first HF hospitalization and the same likelihood of cardiovascular mortality as outpatient management guided by titrating therapy with a goal of achieving a target NT-proBNP of less than 1000 pg/mL.

https://www.ncbi.nlm.nih.gov/m/pubmed/28829876/

Strength of Recommendation = B

Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring — August 25, 2017

Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring

Summary: For pregnant women with well-controlled gestational diabetes mellitus, an approach of advising blood sugar testing 4x daily every other day may lead to higher rates of adherence to testing than an approach of advising blood sugar testing 4x daily every day, with no differences in the need for medical treatment, likelihood of induction, gestational age at delivery, mode of delivery, rate of preeclampsia, likelihood of shoulder dystocia, or likelihood of macrosomia.

https://www.ncbi.nlm.nih.gov/m/pubmed/28594772/

Strength of Recommendation = B

Nonoperative Versus Operative Treatment of Acute Acromio-Clavicular Joint Dislocation. — July 18, 2017

Nonoperative Versus Operative Treatment of Acute Acromio-Clavicular Joint Dislocation.

Summary: For adult patients with complete (grade III, IV, and V) dislocations of the acromio-clavicular (AC) joint, non-operative management with a sling for 4 weeks followed by an exercise program may be associated with a lower level of disability at 6 weeks and 3 months as well as a lower likelihood of needing subsequent surgery, compared to an approach of operative repair with hook plate fixation; although the degree of disability at 2-year follow up may be the same for both approaches.

https://www.ncbi.nlm.nih.gov/m/pubmed/26489055/

Strength of Recommendation = B

Glycemic Control in Severely Burned Patients Using Metformin. — July 5, 2017
Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. — June 27, 2017

Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

Summary: For children with seeking emergency care for an acute exacerbation of asthma, treatment with a single dose of oral dexamethasone (0.3 mg/kg) may be associated with the no differences on the Pediatric Respiratory Assessment Measure (PRAM) score at 4 days compared to treatment with oral prednisolone (1 mg/kg per day for 3 days), but treatment with dexamethasone can be accomplished with fewer doses of medication (once vs daily for 3 days); with dexamethasone associated with lower likelihood of vomiting but a higher likelihood of needing further systemic steroids within 14 days.

https://www.ncbi.nlm.nih.gov/m/pubmed/26460983/

Strength of Recommendation = B

Intra-articular Triamcinolone vs Saline for Patients With Knee Osteoarthritis — June 13, 2017

Intra-articular Triamcinolone vs Saline for Patients With Knee Osteoarthritis

Summary: For patients with symptomatic knee osteoarthritis, an approach of NOT using intra-articular corticosteroid injections may lead to less loss of knee cartilage, compared to an approach of using regular (every-3-month) intra-articular injections of triamcinolone, without any difference pain or function.

https://www.ncbi.nlm.nih.gov/m/pubmed/28510679/

Strength of Recommendation = B

Comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention. — June 6, 2017

Comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention.

Summary: For adults having 2-8 migraine attacks per month (with or without aura), use of melatonin 3 mg daily may provide more people with at least a 50% reduction in headache frequency than amitriptyline 25 mg daily, with a lower likelihood of side effects (such as sleepiness, dry mouth, weight gain or constipation).

https://www.ncbi.nlm.nih.gov/m/pubmed/27165014/

Strength of Recommendation = B

Gluten consumption in adults without celiac disease and risk of coronary heart disease. — May 30, 2017

Gluten consumption in adults without celiac disease and risk of coronary heart disease.

Early Versus Delayed Feeding in Patients With Acute Pancreatitis — May 23, 2017

Early Versus Delayed Feeding in Patients With Acute Pancreatitis

Summary: For patients hospitalized for mild to moderate acute pancreatitis, an approach of early refeeding (at less than 48 hours after admission) may be associated with a shorter length of hospital stay than an approach of delayed refeeding (waiting 48 hours or more after admission), without any increased risk of adverse events.

https://www.ncbi.nlm.nih.gov/m/pubmed/28505667/

Strength of Recommendation = A

Comparative effectiveness of exercise and drug interventions on mortality outcomes — May 16, 2017

Comparative effectiveness of exercise and drug interventions on mortality outcomes

Summary: For patients who have had a stroke, exercise-based rehabilitation (including cardiorespiratory and muscle strengthening exercises) is more effective than medication (either anti-platelet agents or anticoagulants) for reducing mortality; while for patients with established coronary artery disease both medications and exercise-based rehabilitation provide the same (small) reduction in mortality; and for patients with pre-diabetes neither exercise-based rehabilitation nor medications are effective at reducing mortality.

https://www.ncbi.nlm.nih.gov/m/pubmed/26476429/

Strength of Recommendation = A

Timing of oral refeeding in acute pancreatitis. — April 28, 2017
Sitting vs. standing and perception of clinician time at the hospital bedside — April 26, 2017

Sitting vs. standing and perception of clinician time at the hospital bedside

Summary: For patients being seen in hospital, if the physician sits while seeing the patient during hospital rounds, this may lead to the patient perceiving the visit to have been longer than if the physician stands; physician sitting rather than standing may also lead to patients reporting a more positive interaction and a better understanding of their condition.

https://www.ncbi.nlm.nih.gov/m/pubmed/21719234/

Strength of Recommendation = B

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